HomeMy WebLinkAboutX2021-0082 - Permit Application (3),Print Form 'Worksheet for Combo Building & Solar Permit Application
f Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Bwldmg I Grading I —Drainage I— Elec
Project Address (Not mailing addrea
Description of Work
u
New/Add SF I 1 Remodel SF
OWNER'S NAME
Last
f Mech F- Plum Cu Yd
r Flood Fire F Liq F_ Landslide
Garage/New/Add �—
Cu Yd Fill
F_N/A Floor
Suite No
l Use Const Type
# Storiesr— # Units (if Res)F_
Valuation $ q �
Material/LabO ' 5,
1 "`N t First SJ
Owner's Address
Owner's E-mail Address
6 S :
City � �rh t �3 �'�,C�Zip
: State � � - . .. �... _ -
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APPLICANT'S NAME 5
Last
Applicant's Address
City
State r®
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
City
ENGINEER'S NAME
Engineer's Address
City
First I —�--
Applicant's E-mail Address
Zip [� Telephone —
First l
Lic. No. F�
Architect/Designer's E-mail Address
State F® Zip
TelephoneF—
Last
rust I �__. 1- t VW\ Lic. No.
Engineer's E-mail Address 51
Zip F Telephone�—
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
ISETBACKS REAR
I SETBACKS LEFT
USE ZONE
State �—
Lic. No. F-
Classy--
Contractor's E-mail Address
State F Zip r—
Telephone�—
SETBACKS FRONT
PERMIT NO. � ,0
SETBACKS RIGHT
PLAN CHECK NO.
DEVELOPMENT NO _ `�_ PLAN CHECK FEES $